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TOPLINE:

Women who experience gestational diabetes mellitus (GDM) earlier (< 20 weeks) in pregnancy may have worse birth outcomes than other women with late GDM who also begin treatment at 24-28 weeks.

METHODOLOGY:

• The World Health Organization (WHO) has endorsed GDM treatment at 24-28 weeks' gestation, but the TOBOGM study found fewer neonatal complications from early GDM when GDM screening and treatment were initiated before 20 weeks than 24-28 weeks.
• TOBOGM researchers ran a secondary analysis to compare perinatal outcomes of early and late GDM when treatment started at 24-28 weeks' gestation.
• Women (age 18 or older) with singleton pregnancy and at least one risk factor for hyperglycemia were enrolled and underwent an oral glucose tolerance test before 20 weeks' gestation and a repeat test at 24-28 weeks' gestation.
• The secondary analysis looked at women who received GDM treatment at 24-28 weeks only if hyperglycemia was present:
  • Early GDM diagnosed at < 20 weeks' gestation (n = 254).
  • Late GDM present only at 24-28 weeks' gestation (n = 467)
  • No GDM or normoglycemia at 24-28 weeks' gestation (n = 2339; including 121 women with early GDM who had normoglycemia at 24-28 weeks).
• The composite primary outcome was birth before 37 weeks' gestation, birth weight ≥ 4500 g, birth trauma, neonatal respiratory distress, phototherapy, stillbirth or neonatal death, and/or shoulder dystocia.

TAKEAWAY:

• The requirement for insulin therapy (58.7% vs 37.3%; P < .001) and/or metformin therapy (14.2% vs 8.2%; P < .05) was higher in women with early GDM than in those with late GDM.
• Increased odds of adverse composite outcomes were observed in women with early GDM (odds ratio [OR], 1.59; 95% CI, 1.18-2.12) but not late GDM (OR, 1.19; 95% CI, 0.94-1.50), compared with those with normoglycemia.
• The birth centile and rates of preterm birth and neonatal jaundice were also higher in the early GDM group than in the normoglycemia group.
• The rates of neonatal respiratory distress, phototherapy requirement, and neonatal intensive care unit admission were higher in both early and late GDM groups than in the normoglycemia group.

IN PRACTICE:

"Early GDM may necessitate early and more intense interventions for attainment of optimal pregnancy outcomes," the authors stated.

SOURCE:

This study, led by David Simmons, Western Sydney University, Campbelltown, New South Wales, Australia, was published online in Diabetes Care.

LIMITATIONS:

Women were included in this study on the basis of the International Association of the Diabetes and Pregnancy Study Groups/WHO criteria and may not be classified as GDM candidates on the basis of the diagnostic thresholds set by other established guidelines. Also, women with a fasting glucose level > 110 mg/dL were not included. While the majority of the population self-identified as Asian, Middle Eastern, Maori, or Pasifika, a limited presence of Hispanic and Black individuals might affect the generalizability of the results.

DISCLOSURES:

The study was supported by the National Health and Medical Research Council, Region Orebro Research Committee, Medical Scientific Fund of the Mayor of Vienna, South Western Sydney Local Health District Academic Unit, and a Western Sydney University Ainsworth Trust Grant. The authors declared no conflicts of interest.